following drugs are contraindicated in the lactating woman:
Bromocryptine will stop her lactating!
It certainly suppresses lactation when given early.
It has some very serious side-effects; fortunately these are rare.
They include hypotension, hypertension, stroke, myocardial infarction and psychosis.
Remember that it is an ergot alkoloid and they will spring to mind.
There have been fatalities after its use to suppress lactation.
So it seems a somewhat dangerous hammer to crack a nut, however unpleasant.
The British National Formulary states that:
although licensed, bromocryptine & cabergoline should not be used routinely for lactation suppression
and that pain & engorgement can be relieved with analgesics and good support.
If a drug has to be used, cabergoline is preferred to bromocryptine.
The FDA withdrew approval for its use to suppress lactation in the mid-90s.
Its view was that the risks outweighed the potential benefits.
Particularly in a condition for which there are simple, risk-free managements.
Once lactation is established, bromocryptine is not so effective in suppressing it.
There are case reports of successful breast-feeding while on bromocryptine.
So, although it is not absolutely contraindicated, I'd be inclined to stick with the above "true" for the exam.
Sulphonamides may worsen neonatal jaundice (MCQ7, question 12) and cause haemolysis in the babe with glucose-6-phosphatase deficiency.
Labetalol appears to cross to the baby in insufficient quantities to cause problems of beta-blockade, but the baby should be monitored.
Tetracycline taken in pregnancy may cause discoloration of the baby’s teeth.
It is thought that it is unlikely
to do so via breast milk, but is best avoided to be safe.
The BNF has a section specifically about drugs and lactation.
You are unlikely to have to deal with a drug which is not discussed there.
If you do, contact your
Regional Drug Information Centre, if you still have one!
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